Healthy Skepticism Library item: 40

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Publication type: Journal Article

Kemmeren JM, Algra A, Grobbee DE.
Third generation oral contraceptives and risk of venous thrombosis: meta-analysis
BMJ 2001; 323:131-134
http://bmj.bmjjournals.com/cgi/content/full/323/7305/131

Abstract:

OBJECTIVE: To evaluate quantitatively articles that compared effects of second and third generation oral contraceptives on risk of venous thrombosis. DESIGN: Meta-analysis. STUDIES: Cohort and case-control studies assessing risk of venous thromboembolism among women using oral contraceptives before October 1995. MAIN OUTCOME MEASURES: Pooled adjusted odds ratios calculated by a general variance based random effects method. When possible, two by two tables were extracted and combined by the Mantel-Haenszel method. RESULTS: The overall adjusted odds ratio for third versus second generation oral contraceptives was 1.7 (95% confidence interval 1.4 to 2.0; seven studies). Similar risks were found when oral contraceptives containing desogestrel or gestodene were compared with those containing levonorgestrel. Among first time users, the odds ratio for third versus second generation preparations was 3.1 (2.0 to 4.6; four studies). The odds ratio was 2.5 (1.6 to 4.1; five studies) for short term users compared with 2.0 (1.4 to 2.7; five studies) for longer term users. The odds ratio was 1.3 (1.0 to 1.7) in studies funded by the pharmaceutical industry and 2.3 (1.7 to 3.2) in other studies. Differences in age and certainty of diagnosis of venous thrombosis did not affect the results. CONCLUSIONS: This meta-analysis supports the view that third generation oral contraceptives are associated with an increased risk of venous thrombosis compared with second generation oral contraceptives. The increase cannot be explained by several potential biases.

Keywords:
*meta-analysis oral contraceptives drug company sponsored research statistical significance clinical trials SPONSORSHIP: RESEARCH

Notes:

Methodology note: The conclusions of this study are applicable to research on oral contraceptives and may not be generalizable to other groups of drugs. The only database that was searched was Medline. The article does not state if the data extraction was done by a single person; if so biases could have been introduced.
Meta-analysis